Nightmares Be Gone!

Published on 2016 · 07 · 19 by Barb Peck

With a gasp you startle awake, enveloped in terror, heart pounding. You fumble for the light. As you look around the room and notice details, the waves of fear are no longer drowning you. You say calming things: “I’m in safe place, it was just a dream”. You want to go back to sleep but those waves are still lapping at your toes. You get out of bed, move around, splash water on your face, make a cup of tea, and distract yourself with a categories game: “azalea, bougainvillea, carnation, daffodil…”. The dream and the fear have receded. Good work – you have done an excellent job of taking care of yourself in the aftermath of the nightmare. But is there a way to stop having them in the first place?

There are several approaches to dealing with nightmares. The Best Practice Guide for the Treatment of Nightmare Disorder in Adults reviewed many studies and summarized the effectiveness of various approaches. Of these, they identified certain medications that can be helpful, for example, prazosin was recommended in the treatment of PTSD (Post-Traumatic Stress Disorder)-associated nightmares. Of behavioural, or non-medication approaches several were reviewed including (but not limited to) Imagery Rehearsal Therapy (IRT), lucid dreaming, progressive muscle relaxation training, and Eye Movement Desensitization and Reprocessing (EMDR, used for processing traumatic memories). While all of these approaches had some benefits, Imagery Rehearsal Therapy was rated the most highly.

So how is IRT done? It’s actually pretty simple but it does take some regular practice – hence the “rehearsal” part of the name.

Let’s go through the steps, using an example.

Step 1 Write Down Your Nightmare

After you are awake, calm, and in the present moment (no longer caught up in the nightmare) write the nightmare down. The more details the better.

I am walking down the street on a sunny day, enjoying the twittering of small birds. I’m feeling carefree. The sky starts to darken and the birds go silent. I can tell something is wrong. I notice the familiar scent of rotting bananas. My stomach drops and I break out into a cold sweat. It has found me. I look behind me and there it is – large, yellow and looming. I try to run but my feet are slipping on the many peels around me. They are piling higher, I am flailing and falling, I can’t get away…

Just doing this writing step can be therapeutic, but it is even better to keep going through to the next steps.

Step 2 Make Your Changes

I am walking down the street on a sunny day, enjoying the twittering of small birds. I’m feeling carefree. The sky starts to darken and the birds go silent. There’s that smell again. That is my warning. I pull out my whistle and blow it. Within seconds my protector arrives, a large, muscular gorilla. It is friendly to me but very hungry. The Banana has no time to appeal. I feel the pleasant warmth of the sun as the clouds disappear. Any peels on the ground dry up instantly and I continue on my walk, feeling safe and carefree.

Step 3 Mentally Rehearse Your New Script

Play the whole new story out in detail. Do this at least once a day for at a few minutes. You will be telling your mind to replace the old nightmare with this positive new story. Repetition is important.

It’s as simple as that. Even children can do this. Sure there are more things you could do, for example, adding in progressive muscle relaxation before bed. Or, if your nightmares are trauma-related you might want to also work through the source(s) of the nightmares through other therapeutic approaches. But even without that, as one study concluded: “Imagery rehearsal therapy is a brief, well-tolerated treatment that appears to decrease chronic nightmares, improve sleep quality, and decrease PTSD symptom severity.”